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Xu G, Liu X, Wang J, Mei Y, Yang D, He C, Zhong L, Zhu J, Ding H, Fang L. Evaluation of omadacycline regimens for community-acquired bacterial pneumonia patients infected with Staphylococcus Aureus by pharmacokinetic/pharmacodynamic analysis. J Chemother 2024:1-8. [PMID: 38650393 DOI: 10.1080/1120009x.2024.2343963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024]
Abstract
Omadacycline is an FDA-approved agent for community-acquired bacterial pneumonia (CABP). The purpose of this study is to evaluate the effectiveness of omadacycline for treating CABP patients infected with Staphylococcus aureus, including Methicillin-Resistant Staphylococcus aureus (MRSA) and Methicillin-Susceptible Staphylococcus aureus (MSSA), using pharmacokinetic/pharmacodynamic (PK/PD) analysis. Monte Carlo simulations (MCSs) were performed by utilizing omadacycline pharmacokinetic (PK) parameters, minimum inhibitory concentration (MIC) data, and in vivo PK/PD targets to calculate the probability of target attainment (PTA) and cumulative fraction of response (CFR) values for different dose regimens against MRSA and MSSA in CABP patients. A dosage regimen with a PTA or CFR expectation value greater than 90% was considered optimal. For all recommended dose regimens, PTA values for MRSA MIC ≤1 and MSSA MIC ≤4 on days 1, 4, and 7 were greater than 90%. Based on the MIC distribution of Staphylococcus aureus, all dose regimens had CFR values greater than 90% for both MRSA and MSSA. CFR values for different bacterial strains were still greater than 90% within the range of PK/PD target values less than 40, although they gradually decreased with increasing PK/PD target values. PK/PD modeling demonstrated that all recommended dose regimens of omadacycline are highly effective against CABP patients infected with MRSA and MSSA. The study provides theoretical support for the efficacy of omadacycline in different dose regimens.
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Affiliation(s)
- Gaoqi Xu
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Xin Liu
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China
| | - Jiaqi Wang
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Yuqing Mei
- Postgraduate Training Base Alliance of Wenzhou Medical University (Zhejiang Cancer Hospital), Hangzhou, Zhejiang, China
- Department of Clinical Pharmacology, Zhejiang Cancer Hospital, Hangzhou, Zhejiang, China
| | - Dihong Yang
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Chaoneng He
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Like Zhong
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Junfeng Zhu
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Haiying Ding
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Luo Fang
- Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
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Zeggay A, Atchon A, Valot B, Hocquet D, Bertrand X, Bouiller K. Genome Analysis of Methicillin-Resistant and Methicillin-Susceptible Staphylococcus aureus ST398 Strains Isolated from Patients with Invasive Infection. Microorganisms 2023; 11:1446. [PMID: 37374948 DOI: 10.3390/microorganisms11061446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/25/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Using genomic data, we determined the origin of MRSA ST398 isolates responsible for invasive infection in patients with no known livestock contact. METHODS We sequenced the genome of seven MSSA and four MRSA ST398 isolates from patients with invasive infections between 2013 and 2017, using the Illumina technique. Prophage-associated virulence genes and resistance genes were identified. To determine the origin of the isolates, their genome sequences were included in phylogenetic analysis also encompassing the ST398 genomes available on NCBI. RESULTS All isolates carried the φSa3 prophage, but with variations in the immune evasion cluster: type C in MRSA isolates, and type B in MSSA isolates. All MSSA belonged to the spa type t1451. MRSA strains had the same SCCmec type IVa (2B) cassette and belonged to spa types t899, t4132, t1939 and t2922. All MRSA harbored the tetracycline resistance gene, tet(M). Phylogenetic analysis revealed that MSSA isolates belonged to a cluster of human-associated isolates, while MRSA isolates belonged to a cluster containing livestock-associated MRSA. CONCLUSION We showed that the clinical isolates MRSA and MSSA ST398 have different origins. An acquisition of virulence genes by livestock-associated MRSA isolates allows them to induce an invasive infection in human.
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Affiliation(s)
- Abdeljallil Zeggay
- CHU Besançon, Maladies Infectieuses et Tropicales, 25000 Besançon, France
| | - Alban Atchon
- UMR-CNRS 6249 Chrono-Environnement, Université de Franche-Comté, 25000 Besançon, France
- Bioinformatique et Big Data Au Service de La Santé, UFR Santé, Université de Franche-Comté, 25000 Besançon, France
| | - Benoit Valot
- UMR-CNRS 6249 Chrono-Environnement, Université de Franche-Comté, 25000 Besançon, France
- Bioinformatique et Big Data Au Service de La Santé, UFR Santé, Université de Franche-Comté, 25000 Besançon, France
| | - Didier Hocquet
- UMR-CNRS 6249 Chrono-Environnement, Université de Franche-Comté, 25000 Besançon, France
- Bioinformatique et Big Data Au Service de La Santé, UFR Santé, Université de Franche-Comté, 25000 Besançon, France
- CHU Besançon, Hygiène Hospitalière, 25000 Besançon, France
| | - Xavier Bertrand
- UMR-CNRS 6249 Chrono-Environnement, Université de Franche-Comté, 25000 Besançon, France
- CHU Besançon, Hygiène Hospitalière, 25000 Besançon, France
| | - Kevin Bouiller
- CHU Besançon, Maladies Infectieuses et Tropicales, 25000 Besançon, France
- UMR-CNRS 6249 Chrono-Environnement, Université de Franche-Comté, 25000 Besançon, France
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Togitani K, Ogasawara F, Arakawa Y, Sugimura N, Miyazaki R, Kojima K. Psoas and Mediastinal Abscesses during Intravenous Tocilizumab Treatment in Multicentric Castleman Disease. Intern Med 2023; 62:449-452. [PMID: 35732449 PMCID: PMC9970794 DOI: 10.2169/internalmedicine.9519-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Tocilizumab has been used to treat idiopathic multicentric Castleman disease (iMCD). As tocilizumab prevents interleukin-6 from exerting pro-inflammatory effects, there is some concern about a delayed diagnosis of severe infections during tocilizumab treatment. Although serious infections during tocilizumab therapy have been previously described in patients with rheumatoid arthritis, they have not been reported in iMCD. We herein report a case of disseminated Staphylococcus aureus infection after a superficial skin wound followed by psoas and mediastinal abscesses with pyogenic spondylodiscitis in an iMCD patient with diabetes. Physicians should be alert for the occurrence of disseminated S. aureus infection after even minor skin injury during tocilizumab therapy.
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Affiliation(s)
- Kazuto Togitani
- Department of Hematology, Kochi Medical School, Kochi University, Japan
| | - Fumiya Ogasawara
- Department of Hematology, Kochi Medical School, Kochi University, Japan
| | - Yu Arakawa
- Department of Respiratory Medicine and Allergology, Kochi Medical School, Kochi University, Japan
| | - Natsuki Sugimura
- Department of Orthopedic Surgery, Kochi Medical School, Kochi University, Japan
| | - Ryohei Miyazaki
- Department of Thoracic Surgery, Kochi Medical School, Kochi University, Japan
| | - Kensuke Kojima
- Department of Hematology, Kochi Medical School, Kochi University, Japan
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Annavajhala MK, Kelly NE, Geng W, Ferguson SA, Giddins MJ, Grohs EC, Hill-Ricciuti A, Green DA, Saiman L, Uhlemann AC. Genomic and Epidemiological Features of Two Dominant Methicillin-Susceptible Staphylococcus aureus Clones from a Neonatal Intensive Care Unit Surveillance Effort. mSphere 2022; 7:e0040922. [PMID: 36218345 DOI: 10.1128/msphere.00409-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Methicillin-susceptible Staphylococcus aureus (MSSA) is a more prevalent neonatal intensive care unit (NICU) pathogen than methicillin-resistant S. aureus (MRSA). However, the introduction and spread of MSSA, the role of systematic decolonization, and optimal infection prevention and control strategies remain incompletely understood. We previously screened infants hospitalized in a university-affiliated level III to IV NICU twice monthly over 18 months for S. aureus colonization and identified several prevalent staphylococcal protein A (spa) types. Here, we performed whole-genome sequencing (WGS) and phylogenetic comparisons of 140 isolates from predominant spa types t279, t1451, and t571 to examine possible transmission routes and identify genomic and epidemiologic features associated with the spread of dominant clones. We identified two major MSSA clones: sequence type 398 (ST398), common in the local community, and ST1898, not previously encountered in the region. ST398 NICU isolates formed distinct clusters with closely related community isolates from previously published data sets, suggesting multiple sources of acquisition, such as family members or staff, including residents of the local community. In contrast, ST1898 isolates were nearly identical, pointing to clonal expansion within the NICU. Almost all ST1898 isolates harbored plasmids encoding mupirocin resistance (mupA), suggesting an association between the proliferation of this clone and decolonization efforts with mupirocin. Comparative genomics indicated genotype-specific pathways of introduction and spread of MSSA via community-associated (ST398) or health care-associated (ST1898) sources and the potential role of mupirocin resistance in dissemination of ST1898. Future surveillance efforts could benefit from routine genotyping to inform clone-specific infection prevention strategies. IMPORTANCE Methicillin-susceptible Staphylococcus aureus (MSSA) is a significant pathogen in neonates. However, surveillance efforts in neonatal intensive care units (NICUs) have focused primarily on methicillin-resistant S. aureus (MRSA), limiting our understanding of colonizing and infectious MSSA clones which are prevalent in the NICU. Here, we identify two dominant colonizing MSSA clones during an 18-month surveillance effort in a level III to IV NICU, ST398 and ST1898. Using genomic surveillance and phylogenetic analysis, coupled with epidemiological investigation, we found that these two sequence types had distinct modes of spread, namely the suggested exchange with community reservoirs for ST398 and the contribution of antibiotic resistance to dissemination of ST1898 in the health care setting. This study highlights the additional benefits of whole-genome surveillance for colonizing pathogens, beyond routine species identification and genotyping, to inform targeted infection prevention strategies.
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Bouiller K, Zeggay A, Gbaguidi-Haore H, Hocquet D, Chirouze C, Bertrand X. Epidemiology and risk factors of nasal carriage of Staphylococcus aureus CC398 in two distinct cohorts in France. Front Microbiol 2022; 13:1068420. [PMID: 36605518 PMCID: PMC9807596 DOI: 10.3389/fmicb.2022.1068420] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
Background We aimed to determine the prevalence and factors associated with nasal carriage of Staphylococcus aureus CC398 in the community and among hospitalized patients. Methods We conducted a prospective cohort study in a French university hospital and a cross-sectional study in the surrounding region. Results From June 2019 to July 2020, 591 healthy blood donors (HBDs) and 647 hospitalized patients (HPs) were included. S. aureus CC398 was more prevalent in HBDs than in HPs (7.3% [5.3-9.7] vs. 3.8% [2.4-5.5], p = 0.006). Among S. aureus nasal carriers, the prevalence of CC398 isolates was 24.6% in HBDs and 18.3% in HPs (p = 0.19). No MRSA belonged to CC398. In multivariate analysis, prior antibiotic intake in the past year (OR 3.11 [1.37-7.06]) and active smoking (OR 3.01 [1.00-9.05]) were associated with S. aureus CC398 nasal carriage in the HBD cohort. A history of neurological disease was associated with nasal carriage (OR = 5.43 [1.21-24.2]), whereas an age between 82 and 90 years (OR 0.11 [0.02-0.54]) and diabetes (OR 0.18 [0.04-0.85]) were protective factors in the HP cohort. Contact with livestock was not a risk factor in either cohort. Conclusion The prevalence of MSSA CC398 was higher in the community than hospitalized patients. Factors associated with nasal carriage of MSSA CC398 were primarily related to general preconditions. No environmental sources of exposure were identified.
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Affiliation(s)
- Kevin Bouiller
- Service de Maladies Infectieuses et Tropicales – CHU Besancon, Besancon, France,UMR-CNRS 6249 Chrono-environnement, Université Bourgogne Franche-Comté, Besançon, France,*Correspondence: Kevin Bouiller,
| | - Abdeljalil Zeggay
- Service de Maladies Infectieuses et Tropicales – CHU Besancon, Besancon, France
| | - Houssein Gbaguidi-Haore
- UMR-CNRS 6249 Chrono-environnement, Université Bourgogne Franche-Comté, Besançon, France,Service d’Hygiène Hospitalière – CHU Besancon, Besancon, France
| | - Didier Hocquet
- UMR-CNRS 6249 Chrono-environnement, Université Bourgogne Franche-Comté, Besançon, France,Service d’Hygiène Hospitalière – CHU Besancon, Besancon, France
| | - Catherine Chirouze
- Service de Maladies Infectieuses et Tropicales – CHU Besancon, Besancon, France,UMR-CNRS 6249 Chrono-environnement, Université Bourgogne Franche-Comté, Besançon, France
| | - Xavier Bertrand
- UMR-CNRS 6249 Chrono-environnement, Université Bourgogne Franche-Comté, Besançon, France,Service d’Hygiène Hospitalière – CHU Besancon, Besancon, France
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Yildirim F, Sudagidan M, Aydin A, Akyazi I, Bayrakal GM, Yavuz O, Gurel A. In Vivo Pathogenicity of Methicillin-Susceptible Staphylococcus aureus Strains Carrying Panton-Valentine Leukocidin Gene. Life (Basel) 2022; 12. [PMID: 36556491 DOI: 10.3390/life12122126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/07/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
Abstract
Toxin-producing Staphylococcus aureus strains posing a potential risk for public health have long been a topic of scientific research. Effects of Panton-Valentine leukocidin (PVL) on tissue destruction mechanisms and activities of inflammatory cells were presented in animal models of pneumonia and skin infections induced by PVL-producing S. aureus strains. This study aimed to demonstrate the in vivo pathogenicity of PVL-producing S. aureus strains isolated from some foodstuffs, which can be a potential risk to public health. PVL-positive methicillin-susceptible S. aureus (MSSA) strains M1 and YF1B-b isolated from different foodstuffs and a PVL-positive MSSA strain HT480 (positive control) were administered to New Zealand rabbits. Blood samples were harvested three and six hours after the intratracheal inoculation. Lung tissue samples were collected for gross and microscopic exams and immunohistochemical (IHC) demonstration of IL-6, IL8, IL-10, and TNF-α expressions. Serum cytokine levels were also measured by ELISA. The strains isolated from lung tissue samples were confirmed by pulsed-field gel electrophoresis. The development of acute necrotising pneumonia and a significant elevation in IL-6, IL-8, IL-10, and TNF-α expressions demonstrated the significance of foodborne PVL-positive MSSA strains in public health for the first time.
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Pumipuntu N, Chamnandee T, Saengthong K, Pathomthanasarn S, Tanee T, Kyes P, Thamsenanupap P, Karaket A, Roberts MC, Kyes RC. Investigation of methicillin-resistant Staphylococcus aureus, methicillin-susceptible Staphylococcus aureus, and Staphylococcus argenteus from wild long-tailed macaques ( Macaca fascicularis) at Kosumpee Forest Park, Maha Sarakham, Thailand. Vet World 2022; 15:2693-2698. [PMID: 36590126 PMCID: PMC9798064 DOI: 10.14202/vetworld.2022.2693-2698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 10/13/2022] [Indexed: 11/27/2022] Open
Abstract
Background and Aim In the past, the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) infections in both humans and animals has increased across Thailand. Staphylococcus argenteus has been associated with infections among humans, exotic pets, and livestock. Both species have been identified in non-human primate species from geographically diverse locations but not from non-human primates in Thailand. This study aimed to determine the presence of MRSA/methicillin-susceptible S. aureus (MSSA) and S. argenteus isolates collected from buccal swab samples in Macaca fascicularis at Kosumpee Forest Park (KFP), Maha Sarakham, Northeast Thailand. Materials and Methods Aseptic buccal swab samples were collected from 30 free-ranging macaques in November 2018. All isolates were tested using multiple biochemical tests and S. aureus latex slide agglutination test. Presumptive S. aureus isolates were tested for the presence of the mecA gene using polymerase chain reaction (PCR) assays. The isolates were phenotypically determined to be resistant to a β-lactam antibiotic using the disk diffusion method with a 30 mg cefoxitin disk. The isolates were analyzed by PCR for the non-ribosomal peptide synthetase (NRPS) gene to distinguish S. argenteus from S. aureus. Results Fifteen macaques (50%) were colonized with S. aureus and 21 isolates were characterized. Three of the macaques carried both the MRSA and MSSA isolate. One animal carried both MRSA and S. argenteus isolate, and one animal carried only S. argenteus. The NRPS gene analysis confirmed that 2 isolates (9.52%) were S. argenteus and 19 isolates (90.48%) were S. aureus [five MSSA and 14 MRSA]. Conclusion This study is the first to identify MRSA/MSSA and S. argenteus in wild free-ranging M. fascicularis from Thailand at the KFP in Maha Sarakham. This study is also the first report on the occurrence of S. argenteus carriage in M. fascicularis from Thailand.
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Affiliation(s)
- Natapol Pumipuntu
- One Health Research Unit, Mahasarakham University, Maha Sarakham, Thailand,Veterinary Infectious Disease Research Unit, Mahasarakham University, Maha Sarakham, Thailand,Faculty of Veterinary Sciences, Mahasarakham University, Maha Sarakham, Thailand,Corresponding author: Natapol Pumipuntu, e-mail: Co-authors: TC: , KS: , SP: , TT: , PK: , PT: , AK: , MCR: , RCK:
| | - Thanyaphorn Chamnandee
- One Health Research Unit, Mahasarakham University, Maha Sarakham, Thailand,Faculty of Veterinary Sciences, Mahasarakham University, Maha Sarakham, Thailand
| | - Kittisak Saengthong
- One Health Research Unit, Mahasarakham University, Maha Sarakham, Thailand,Faculty of Veterinary Sciences, Mahasarakham University, Maha Sarakham, Thailand
| | - Suvit Pathomthanasarn
- One Health Research Unit, Mahasarakham University, Maha Sarakham, Thailand,Faculty of Veterinary Sciences, Mahasarakham University, Maha Sarakham, Thailand
| | - Tawatchai Tanee
- One Health Research Unit, Mahasarakham University, Maha Sarakham, Thailand,Faculty of Environment and Resource Studies, Mahasarakham University, Maha Sarakham, Thailand
| | - Pensri Kyes
- Department of Psychology, Center for Global Field Study, and Washington National Primate Research Center, University of Washington, Seattle, Washington, USA
| | - Penkhae Thamsenanupap
- One Health Research Unit, Mahasarakham University, Maha Sarakham, Thailand,Faculty of Environment and Resource Studies, Mahasarakham University, Maha Sarakham, Thailand
| | - Apichat Karaket
- Department of National Parks, Wildlife and Plant Conservation, Bangkok, Thailand
| | - Marilyn C. Roberts
- Department of Environmental and Occupational Health, University of Washington, Seattle, Washington, USA
| | - Randall C. Kyes
- Departments of Psychology, Global Health, and Anthropology, Center for Global Field Study, and Washington National Primate Research Center, University of Washington, Seattle, Washington, USA
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Zhu H, Luo H, Zhong Q, Cao X, Gu S, Peng S, Xiao Y, Chen Y, Hang Y, Fang X, Zou S, Yu F, Hu L. Comparison of Molecular Characteristics Between Methicillin-Resistant and -Susceptible Staphylococcus aureus Clinical Isolates by Whole-Genome Sequencing. Infect Drug Resist 2022; 15:2949-2958. [PMID: 35706925 PMCID: PMC9190744 DOI: 10.2147/idr.s359654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/12/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction The transmission of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible Staphylococcus aureus (MSSA) are great public health concern worldwide. To better understand S. aureus evolution and dissemination, we compared the molecular features of MSSA and MRSA isolates. Methods In this study, 74 MSSA and 102 MRSA non-duplicate isolates were recovered from clinical samples between 2016 and 2020. Molecular epidemiology, antimicrobial resistance determinants, and virulence gene profiles were carried out by whole-genome sequencing (WGS). Results Twenty distinct sequence types were identified in MRSA isolates, with the most common being ST59, ST630, and ST338. The major genotypes of MSSA were ST188 and ST7. The toxin genes clfA, sek, and seq were significantly associated with MRSA, while splA/B, clfB, map, sdrC/D, and sem-sen-seo-seu were detected more frequently in MSSA isolates than MRSA (P < 0.05). The tst positive isolates were more commonly identified in CC1 and CC72, whereas lukE/D was mainly found in the CC7, CC15, CC88, and completely absent in CC59 clones. Conclusion Our results compared the genetic diversity between MRSA and MSSA strains, suggesting efforts to fight infections caused by MSSA need to be intensified due to MSSA isolates carrying wide range of virulence factors. Comparative epidemiological studies of large populations of MSSA and MRSA will be necessary in the future to understand how MSSA and MRSA populations may co-evolve and interact in the future.
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Affiliation(s)
- Hongying Zhu
- Department of Clinical Laboratory Medicine, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Hong Luo
- Department of Clinical Laboratory Medicine, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Qiaoshi Zhong
- Department of Clinical Laboratory Medicine, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Xingwei Cao
- Department of Clinical Laboratory Medicine, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Shumin Gu
- Department of Clinical Laboratory Medicine, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Suqin Peng
- Department of Clinical Laboratory Medicine, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Yanping Xiao
- Department of Clinical Laboratory Medicine, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Yanhui Chen
- Department of Clinical Laboratory Medicine, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Yaping Hang
- Department of Clinical Laboratory Medicine, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Xueyao Fang
- Department of Clinical Laboratory Medicine, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Shan Zou
- Department of Clinical Laboratory Medicine, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Fangyou Yu
- Department of Clinical Laboratory Medicine, Shanghai Pulmonary Hospital, Tongji UniversitySchool of Medicine, Shanghai, 200082, People's Republic of China
| | - Longhua Hu
- Department of Clinical Laboratory Medicine, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
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Herrera-Hidalgo L, Luque-Márquez R, de Alarcon A, Guisado-Gil AB, Gutierrez-Gutierrez B, Navarro-Amuedo MD, Praena-Segovia J, Carmona-Caballero JM, Fraile-Ramos E, Gutierrez-Valencia A, Lopez-Cortes LE, Gil-Navarro MV. Clinical Outcomes of an Innovative Cefazolin Delivery Program for MSSA Infections in OPAT. J Clin Med 2022; 11. [PMID: 35329878 DOI: 10.3390/jcm11061551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/09/2022] [Accepted: 03/09/2022] [Indexed: 02/04/2023] Open
Abstract
Cefazolin is a recommended treatment for methicillin-susceptible Staphylococcus aureus (MSSA) infections that has been successfully used in outpatient parenteral antibiotic therapy (OPAT) programs. The aim of this study was to assess the clinical outcomes of cefazolin delivered each day (Group 24) vs. every two days (Group 48) for MSSA infections in OPAT programs. It was a prospective observational study with retrospective analysis of a cohort of MSSA infections attended in OPAT. The primary outcome was treatment success, defined as completing the antimicrobial regimen without death, treatment discontinuation, or readmission during treatment and follow-up. A univariate and multivariate logistic regression model was built. A two-sided p < 0.05 was considered statistically significant. Of the 149 MSSA infections treated with cefazolin 2 g/8 h in OPATs, 94 and 55 patients were included in the delivery Group 24 and Group 48, respectively. Treatment failure and unplanned readmission rates were similar in both groups (11.7% vs. 7.3% p = 0.752 and 8.5% vs. 5.5% p = 0.491). There was a significant increase in vascular access complications in Group 24 (33.0%) with respect to Group 48 (7.3%) (p < 0.001). Treating uncomplicated MSSA infection with cefazolin home-delivered every two days through an OPAT program is not associated with an increased risk of treatment failure and entails a significant reduction in resource consumption compared to daily delivery.
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Jin Y, Zhou W, Zhan Q, Chen Y, Luo Q, Shen P, Xiao Y. Genomic epidemiology and characterisation of penicillin-sensitive Staphylococcus aureus isolates from invasive bloodstream infections in China: an increasing prevalence and higher diversity in genetic typing be revealed. Emerg Microbes Infect 2022; 11:326-336. [PMID: 34991434 PMCID: PMC8786255 DOI: 10.1080/22221751.2022.2027218] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Many countries have reported increasing rates of penicillin-susceptible methicillin-sensitive Staphylococcus aureus (MSSA-PENS). To date, there is relatively little known about the current situation and molecular characteristics of MSSA-PENS in China. In this study, we carried out a laboratory-based multi-region retrospective study to investigate the genomic epidemiology and characterisation of MSSA-PENS isolated from invasive bloodstream infections (BSIs) across 17 provinces. The prevalence of MSSA-PENS isolates increased significantly over the 6-year period, with the proportion increasing from 3.51% in 2014-8.80% in 2019, an average relative increase of 22.14% per year (95% confidence interval 9.67%-34.61%, P for trend <0.001), suggesting that China is experiencing a resurgence of MSSA-PENS. Phylogenetic analysis showed a higher strain diversity occurred; the most frequent clonal complexes (CCs) identified were CC188 (17.14%), CC398 (15.71%) and CC5 (15.71%). Over half of MSSA-PENS strains were pan-susceptible, with erythromycin the most frequent resistance observed. Moreover, 25 isolates were identified as immune evasion cluster negative, including CC15, CC188 and CC1, and 6 strains encoded the Panton-Valentine leucocidin gene. Importantly, virulence assays showed that MSSA-PENS exhibited a level of virulence comparable to that of penicillin-resistant MSSA (MSSA-PENR), indicating that more-sensitive strains should not be mistaken for lacking aggressiveness in vivo. Furthermore, 11 of these isolates were confirmed as blaZ positive but phenotype sensitive, with different amino acid changes in blaZ. Our data support the recommendation to clinicians regarding the usage of penicillin in invasive BSIs caused by MSSA-PENS, which might create a novel opportunity for better antimicrobial stewardship in the future.
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Affiliation(s)
- Ye Jin
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Wangxiao Zhou
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Qing Zhan
- Infection Control Department, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Yunbo Chen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Qixia Luo
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Ping Shen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Yonghong Xiao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.,Jinan Microecological Biomedicine Shandong Laboratory, Jinan, People's Republic of China
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11
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Obed MN, Toresani I, Mykietuk A, Nannini EC. Ceftaroline as salvage therapy for methicillin susceptible Staphylococcus aureus complicated bacteremia. Medicina (B Aires) 2022; 82:794-797. [PMID: 36220043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
Infections caused by methicillin-susceptible Staphylococcus aureus (MSSA) are still associated with significant morbidity and mortality. Treatment failures of cefazolin (CFZ) have been reported and probably related to the inoculum effect. New treatments for severe MSSA infections are needed and ceftaroline fosamil (CPT) could be an option. Our aim was to describe the clinical characteristics of five patients with complicated MSSA bacteremia failing CFZ and successfully treated with CPT. We performed a retrospective chart review in a Hospital in Buenos Aires, Argentina; in a 12-month period, five patients (24%) of 21 with MSSA bacteremia experienced CFZ failure and were salvaged with CPT. The median time of CFZ therapy was 10 days before changing to CPT; four patients had evidence of metastatic spread and 2 had endocarditis. All patients experienced microbiological and clinical cure with CPT, which was used as monotherapy in 4 and in combination with daptomycin in another. One patient discontinued CPT due to neutropenia on day 23 of treatment. In patients with MSSA BSI failing current therapy, CPT could be a good therapeutic option.
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Affiliation(s)
- Mora N Obed
- Instituto Médico Platense, La Plata, Buenos Aires, Argentina
| | - Inés Toresani
- Facultad de Ciencias Bioquímicas, Universidad Nacional de Rosario, Santa Fe, Argentina
| | - Analía Mykietuk
- Instituto Médico Platense, La Plata, Buenos Aires, Argentina
| | - Esteban C Nannini
- Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Santa Fe, Argentina. E-mail:
- Instituto de Inmunología Clínica y Experimental Rosario (IDICER), CONICET, Rosario, Santa Fe, Argentina
- Sanatorio Británico, Rosario, Santa Fe, Argentina
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12
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Zhao X, Hu M, Zhao C, Zhang Q, Li L, Zhang Y, Luo Y, Liu Y. Whole-Genome Epidemiology and Characterization of Methicillin-Susceptible Staphylococcus aureus ST398 From Retail Pork and Bulk Tank Milk in Shandong, China. Front Microbiol 2021; 12:764105. [PMID: 34917050 PMCID: PMC8670001 DOI: 10.3389/fmicb.2021.764105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 11/03/2021] [Indexed: 11/13/2022] Open
Abstract
Staphylococcus aureus (S. aureus) is now regarded as a zoonotic agent. Methicillin-susceptible S. aureus (MSSA) ST398 is a livestock-associated bacterium that is most prevalent in China, but there are currently no data available for Shandong. Therefore, the aim of this study was to investigate the epidemiology and characterization of MSSA ST398 from retail pork and bulk tank milk (BTM) in Shandong. A total of 67 S. aureus isolates were collected from retail pork between November 2017 and June 2018. Among the isolates, high antimicrobial resistance rates were observed for penicillin (97.0%), and 92.5% of the isolates were multi-drug resistant (MDR). Eight sequence types (STs) were identified in the retail pork isolates, and the predominant type was ST15 (n=26), which was followed by ST398 (n=14). Staphylococcal protein A gene (spa) typing identified spa types t034 and t1255 in MSSA ST398 from retail pork. Using whole-genome sequencing analysis, we described the phylogeny of 29 MSSA ST398 isolates that were obtained from retail pork (n=14) and BTM (n=15). The phylogenetic tree showed that the MSSA ST398 isolates from different sources had the same lineage. Among the 29 MSSA ST398 isolates, five resistance genes were detected, and all isolates carried DHA-1. Fifteen toxin genes were detected, and all isolates carried eta, hla, and hlb. In conclusion, this study found that a high risk for MSSA ST398 was present in retail pork and BTM. These findings have major implications for how investigations of MSSA ST398 outbreaks should be conducted in the One-Health context.
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Affiliation(s)
- Xiaonan Zhao
- Institute of Animal Science and Veterinary Medicine, Shandong Academy of Agricultural Sciences, Shandong, China
| | - Ming Hu
- Institute of Animal Science and Veterinary Medicine, Shandong Academy of Agricultural Sciences, Shandong, China
| | - Cui Zhao
- Tai'an animal disease prevention and control center, Shandong, China
| | - Qing Zhang
- Institute of Animal Science and Veterinary Medicine, Shandong Academy of Agricultural Sciences, Shandong, China
| | - Lulu Li
- Institute of Animal Science and Veterinary Medicine, Shandong Academy of Agricultural Sciences, Shandong, China
| | - Yin Zhang
- Institute of Animal Science and Veterinary Medicine, Shandong Academy of Agricultural Sciences, Shandong, China
| | - Yanbo Luo
- Institute of Animal Science and Veterinary Medicine, Shandong Academy of Agricultural Sciences, Shandong, China
| | - Yuqing Liu
- Institute of Animal Science and Veterinary Medicine, Shandong Academy of Agricultural Sciences, Shandong, China
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13
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Uda A, Onuma K, Shigemura K, Kitagawa K, Yan Y, Osawa K, Yano I, Miyara T. Impact of Cefazolin Shortage on Clinical Outcomes of Adult Patients with Bacteremia Caused by Methicillin-Susceptible Staphylococcus aureus in a Tertiary Care University Hospital. Antibiotics (Basel) 2021; 10:antibiotics10101247. [PMID: 34680827 PMCID: PMC8532967 DOI: 10.3390/antibiotics10101247] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/09/2021] [Accepted: 10/12/2021] [Indexed: 12/20/2022] Open
Abstract
Cefazolin is an essential antibiotic used for treating bacteremia; in particular, it is recommended as a first-line agent for infections caused by methicillin-susceptible Staphylococcusaureus (MSSA). In March 2019, problems with a major antibiotic supplier caused a critical shortage of cefazolin in Japan; however, the impact of the cefazolin shortage on clinical outcomes remains unknown. This study aimed to evaluate the effect of the cefazolin shortage in patients with MSSA bacteremia. Data from 75 patients were compared between the pre-shortage (March 2018–January 2019, n = 39) and post-shortage (March 2019–January 2020, n = 36) periods. There were no significant differences in the demographic characteristics between the two groups, and the cefazolin shortage did not worsen clinical outcomes such as adverse drug reactions, treatment failure, and 30-day mortality. In the post-shortage group, ampicillin/sulbactam and benzylpenicillin were more frequently administered as alternative antibiotics for empirical and definitive therapy (10% vs. 31%, p = 0.042; 0% vs. 19%, p = 0.004, respectively). Multivariate analysis revealed that the broad-spectrum antibiotics for definitive therapy, such as antipseudomonal penicillin, were associated with treatment failure in patients with MSSA bacteremia (OR = 17, p = 0.003). Hence, narrow-spectrum antibiotics should be prescribed for MSSA bacteremia as alternatives during a cefazolin shortage.
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Affiliation(s)
- Atsushi Uda
- Department of Infection Control and Prevention, Kobe University Hospital, Kobe 650-0017, Japan; (K.O.); (K.S.); (T.M.)
- Department of Pharmacy, Kobe University Hospital, Kobe 650-0017, Japan;
- Correspondence: ; Tel.: +81-78-382-5111
| | - Kenichiro Onuma
- Department of Infection Control and Prevention, Kobe University Hospital, Kobe 650-0017, Japan; (K.O.); (K.S.); (T.M.)
- Department of Clinical Laboratory, Kobe University Hospital, Kobe 650-0017, Japan
| | - Katsumi Shigemura
- Department of Infection Control and Prevention, Kobe University Hospital, Kobe 650-0017, Japan; (K.O.); (K.S.); (T.M.)
- Division of Infectious Diseases, Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe 654-0142, Japan;
- Division of Urology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan;
| | - Koichi Kitagawa
- Division of Infectious Diseases, Department of Public Health, Kobe University Graduate School of Health Sciences, Kobe 654-0142, Japan;
- Division of Advanced Medical Science, Kobe University Graduate School of Science, Technology and Innovation, Kobe 657-8501, Japan
| | - Yonmin Yan
- Division of Urology, Kobe University Graduate School of Medicine, Kobe 650-0017, Japan;
| | - Kayo Osawa
- Department of Medical Technology, Kobe Tokiwa University, Kobe 653-0838, Japan;
| | - Ikuko Yano
- Department of Pharmacy, Kobe University Hospital, Kobe 650-0017, Japan;
| | - Takayuki Miyara
- Department of Infection Control and Prevention, Kobe University Hospital, Kobe 650-0017, Japan; (K.O.); (K.S.); (T.M.)
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14
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Kumamoto HM, Yaita K. Nosocomial Native Valve Endocarditis due to Methicillin-Susceptible Staphylococcus aureus in a Patient with Psoriatic Arthritis. Kurume Med J 2021; 66:247-251. [PMID: 34544940 DOI: 10.2739/kurumemedj.ms664002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Nosocomial infective endocarditis is a relatively rare, but critical disease. A Japanese man in his 80s with psoriatic arthritis that was being treated with prednisolone was admitted for dyspnea. The first diagnosis was healthcare-associated pneumonia, and piperacillin/tazobactam was started. The patient's blood culture was negative at the time of admission. During the treatment, acute kidney injury occurred due to the use of antibiotics. Hemodialysis was performed via a central venous catheter in the internal jugular vein. After treatment of pneumonia, the patient experienced a sudden onset of fever accompanied by a loss of consciousness. Blood cultures from the peripheral vein and the central venous catheter were positive for methicillin-susceptible Staphylococcus aureus. A transthoracic echocardiography revealed stringy strands of vegetation attached to the native mitral valve. Magnetic resonance imagings also showed a shower of emboli to the brain. Ceftriaxone and vancomycin were administered; however, the patient died following a massive cerebral infarction. Instances of in-hospital mortality from nosocomial endocarditis are higher than the rates of community-acquired endocarditis. Clinicians should pay close attention to risk factors for nosocomial infective endocarditis. These risk factors include long-term indwelling vascular devices, psoriatic arthritis and corticosteroid therapy.
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Affiliation(s)
| | - Kenichiro Yaita
- Division of Infectious Diseases, Chidoribashi General Hospital
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15
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Grohs E, Hill-Ricciuti A, Kelly N, Messina M, Green DA, Geng W, Annavajhala MK, Zachariah P, Mathema B, Uhlemann AC, Saiman L. Spa Typing of Staphylococcus aureus in a Neonatal Intensive Care Unit During Routine Surveillance. J Pediatric Infect Dis Soc 2021; 10:766-773. [PMID: 34129043 PMCID: PMC8370566 DOI: 10.1093/jpids/piab014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/24/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Staphylococcus aureus protein A (spa) typing can be used to expand characterization of the epidemiology of methicillin-susceptible S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA) in neonatal intensive care units (NICU). METHODS From January 2017 to June 2018, twice-monthly surveillance for S. aureus was performed in an academically affiliated NICU. Decolonization of infants colonized with S. aureus included chlorhexidine gluconate bathing and/or mupirocin for those with mupirocin-susceptible strains. Spa typing and mupirocin-resistance testing were performed. Demographic and clinical characteristics were compared between infants colonized with MSSA vs MRSA and infants with and without the most common MSSA spa type, MSSA-t279. RESULTS Overall, 14% and 2% of 1556 hospitalized infants had positive surveillance cultures for MSSA and MRSA, respectively. Thirty-six infants harbored unique MSSA spa types, 5 infants harbored unique MRSA spa types, and 30 MSSA and 6 MRSA spa types were identified in ≥2 infants. No outbreaks were identified during the study period. MSSA-t279 was isolated from 3% of infants and largely detected from infants hospitalized in one section of the NICU; 96% of t279 isolates were mupirocin resistant. Infection rates, length of hospitalization, and mortality were similar among infants initially colonized with t279 vs other MSSA spa types. CONCLUSIONS The MSSA colonization burden was 5-fold larger than that of MRSA. Numerous unique spa types were identified. The most common spa type, MSSA-t279, was not associated with increased morbidity or mortality but was mupirocin resistant and associated with clustered NICU beds. This suggests potential transmission from the environment, shared staff, and/or workflow issues requiring further study. Other decolonization strategies for S. aureus in the NICU are needed.
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Affiliation(s)
- Emily Grohs
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA,Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA,Present Affiliation: Department of Infection Prevention & Control, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Alexandra Hill-Ricciuti
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Nicole Kelly
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Maria Messina
- Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Daniel A Green
- Department of Pathology, Columbia University Irving Medical Center, New York, New York, USA
| | - Wenjing Geng
- Neonatal Center, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, China
| | - Medini K Annavajhala
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Philip Zachariah
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA,Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Barun Mathema
- Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
| | - Anne-Catrin Uhlemann
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Lisa Saiman
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA,Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, New York, USA,Corresponding Author: Lisa Saiman, MD MPH, Department of Pediatrics, Columbia University Irving Medical Center, 622 West 168th Street, PH 4-470, New York, NY 10032, USA. E-mail:
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16
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Xu Z, Chen J, Vougas K, Shah A, Shah H, Misra R, Mkrtchyan HV. Comparative Proteomic Profiling of Methicillin-Susceptible and Resistant Staphylococcus aureus. Proteomics 2020; 20:e1900221. [PMID: 31872541 DOI: 10.1002/pmic.201900221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 12/10/2019] [Indexed: 11/08/2022]
Abstract
Staphylococcus aureus is a highly successful human pathogen responsible for a wide range of infections. This study provides insights into the virulence, pathogenicity, and antimicrobial resistance determinants of methicillin-susceptible and methicillin-resistant S. aureus (MSSA; MRSA) recovered from non-healthcare environments. Three environmental MSSA and three environmental MRSA are selected for proteomic profiling using isobaric tag for relative and absolute quantitation tandem mass spectrometry (iTRAQ MS/MS). Gene Ontology annotation and Kyoto Encyclopedia of Genes and Genomes pathway annotation are applied to interpret the functions of the proteins detected. 792 proteins are identified in MSSA and MRSA. Comparative analysis of MRSA and MSSA reveals that 8 of out 792 proteins are upregulated and 156 are downregulated. Proteins that have differences in abundance are predominantly involved in catalytic and binding activity. Among 164 differently abundant proteins, 29 are involved in pathogenesis, antimicrobial resistance, stress response, mismatch repair, and cell wall synthesis. Twenty-two proteins associated with pathogenicity including SPA, SBI, CLFA, and DLT are upregulated in MRSA. Moreover, the upregulated pathogenic protein ENTC2 in MSSA is determined to be a super antigen, potentially capable of triggering toxic shock syndrome in the host. Enhanced pathogenicity, antimicrobial resistance, and stress response are observed in MRSA compared to MSSA.
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Affiliation(s)
- Zhen Xu
- Department of Sanitary Toxicology and Chemistry, Tianjin Key Laboratory of Environment, Nutrition and Public Health, Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin Medical University, Tianjin, 300070, China.,School of Biological and Chemical Sciences, Queen Mary University of London, London, E1 4NS, UK
| | - Jiazhen Chen
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Kostas Vougas
- Biotechnology Division, Biomedical Research Foundation of the Academy of Athens, Athens, 115 27, Greece
| | - Ajit Shah
- Department of Natural Sciences, Middlesex University, London, NW4 4BT, UK
| | - Haroun Shah
- Department of Natural Sciences, Middlesex University, London, NW4 4BT, UK
| | - Raju Misra
- Molecular Biology, Core Research Laboratories, Natural History Museum, Cromwell Rd, London, SW7 5BD, UK
| | - Hermine V Mkrtchyan
- School of Biological and Chemical Sciences, Queen Mary University of London, London, E1 4NS, UK.,School of Health, Sport and Biosciences, University of East London, London, E15 4LZ, UK
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Bouiller K, Bertrand X, Hocquet D, Chirouze C. Human Infection of Methicillin-Susceptible Staphylococcus aureus CC398: A Review. Microorganisms 2020; 8:microorganisms8111737. [PMID: 33167581 PMCID: PMC7694499 DOI: 10.3390/microorganisms8111737] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/04/2020] [Accepted: 11/04/2020] [Indexed: 12/25/2022] Open
Abstract
Staphylococcus aureus (SA) belonging to the clonal complex 398 (CC398) took a special place within the species due to its spread throughout the world. SA CC398 is broadly separated in two subpopulations: livestock-associated methicillin-resistant SA (MRSA) and human-associated methicillin-susceptible SA (MSSA). Here, we reviewed the global epidemiology of SA CC398 in human clinical infections and focused on MSSA CC398. The last common ancestor of SA CC398 was probably a human-adapted prophage φSa3-positive MSSA CC398 strain, but the multiple transmissions between human and animal made its evolution complex. MSSA and MRSA CC398 had different geographical evolutions. Although MSSA was present in several countries all over the world, it was mainly reported in China and in France with a prevalence about 20%. MSSA CC398 was frequently implicated in severe infections such as bloodstream infections, endocarditis, and bone joint infections whereas MRSA CC398 was mainly reported in skin and soft tissue. The spread of the MSSA CC398 clone is worldwide but with a heterogeneous prevalence. The prophage φSa3 played a crucial role in the adaptation to the human niche and in the virulence of MSSA CC398. However, the biological features that allowed the recent spread of this lineage are still far from being fully understood.
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Affiliation(s)
- Kevin Bouiller
- Maladies Infectieuses et Tropicales—Centre Hospitalier Universitaire, 25030 Besançon, France;
- UMR-CNRS 6249 Chrono-Environnement, Université Bourgogne Franche-Comté, 25000 Besançon, France; (X.B.); (D.H.)
- Correspondence:
| | - Xavier Bertrand
- UMR-CNRS 6249 Chrono-Environnement, Université Bourgogne Franche-Comté, 25000 Besançon, France; (X.B.); (D.H.)
- Hygiène Hospitalière—Centre Hospitalier Universitaire, 25030 Besançon, France
| | - Didier Hocquet
- UMR-CNRS 6249 Chrono-Environnement, Université Bourgogne Franche-Comté, 25000 Besançon, France; (X.B.); (D.H.)
- Hygiène Hospitalière—Centre Hospitalier Universitaire, 25030 Besançon, France
| | - Catherine Chirouze
- Maladies Infectieuses et Tropicales—Centre Hospitalier Universitaire, 25030 Besançon, France;
- UMR-CNRS 6249 Chrono-Environnement, Université Bourgogne Franche-Comté, 25000 Besançon, France; (X.B.); (D.H.)
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18
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Coombs GW, Daley DA, Mowlaboccus S, Lee YT, Pang S. Australian Group on Antimicrobial Resistance (AGAR) Australian Staphylococcus aureus Sepsis Outcome Programme (ASSOP) Annual Report 2018. ACTA ACUST UNITED AC 2020; 44. [PMID: 32178604 DOI: 10.33321/cdi.2020.44.18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
From 1 January to 31 December 2018, thirty-six institutions around Australia participated in the Australian Staphylococcus aureus Sepsis Outcome Programme (ASSOP). The aim of ASSOP 2018 was to determine the proportion of Staphylococcus aureus bacteraemia (SAB) isolates in Australia that are antimicrobial resistant, with particular emphasis on susceptibility to methicillin, and to characterise the molecular epidemiology of the methicillin-resistant isolates. A total of 2,673 S. aureus bacteraemia episodes were reported, of which 78.9% were community-onset. A total of 17.4% of S. aureus isolates were methicillin resistant. The 30-day all-cause mortality associated with methicillin-resistant SAB was 17.1% which was not significantly higher than the 13.6% mortality associated with methicillin-susceptible SAB (p = 0.1). With the exception of the β-lactams and erythromycin, antimicrobial resistance in methicillin-susceptible S. aureus was rare. However in addition to the β-lactams approximately 42% of methicillin-resistant S. aureus (MRSA) were resistant to erythromycin, 36% to ciprofloxacin and approximately 13% resistant to co-trimoxazole, tetracycline and gentamicin. When applying the EUCAST breakpoints teicoplanin resistance was detected in two S. aureus isolates. Resistance was not detected for vancomycin and linezolid. Resistance to non-beta-lactam antimicrobials was largely attributable to two healthcare-associated MRSA clones: ST22-IV [2B] (EMRSA-15) and ST239-III [3A] (Aus-2/3 EMRSA). The ST22-IV [2B] (EMRSA-15) clone is the predominant healthcare-associated clone in Australia. Seventy-eight percent of methicillin-resistant SAB episodes in 2018 were due to community-associated clones. Although polyclonal, approximately 76.3% of community-associated clones were characterised as ST93-IV [2B] (Queensland CA-MRSA), ST5-IV [2B], ST45-VT [5C2&5], ST1-IV [2B], ST30-IV [2B], ST78-IV [2B] and ST97-IV [2B]. Community-associated MRSA, in particular the ST45-VT [5C2&5] clone, has acquired multiple antimicrobial resistance determinants including ciprofloxacin, erythromycin, clindamycin, gentamicin and tetracycline. The ST45-VT [5C2&5] clone accounted for 11.7% of CA-MRSA. As CA-MRSA is well established in the Australian community, it is important that antimicrobial resistance patterns in community- and healthcare-associated SAB are monitored, as this information will guide therapeutic practices in treating S. aureus sepsis.
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Affiliation(s)
- Geoffrey W Coombs
- Antimicrobial Resistance and Infectious Disease (AMRID) Research Laboratory, Murdoch University, Murdoch, Western Australia, Australia; Department of Microbiology, PathWest Laboratory Medicine-WA, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Denise A Daley
- Department of Microbiology, PathWest Laboratory Medicine-WA, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; Australian Group on Antimicrobial Resistance, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Shakeel Mowlaboccus
- Antimicrobial Resistance and Infectious Disease (AMRID) Research Laboratory, Murdoch University, Murdoch, Western Australia, Australia
| | - Yung Thin Lee
- Antimicrobial Resistance and Infectious Disease (AMRID) Research Laboratory, Murdoch University, Murdoch, Western Australia, Australia
| | - Stanley Pang
- Antimicrobial Resistance and Infectious Disease (AMRID) Research Laboratory, Murdoch University, Murdoch, Western Australia, Australia; Department of Microbiology, PathWest Laboratory Medicine-WA, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
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Chabán MF, I Antoniou A, Karagianni C, Toumpa D, Joray MB, Bocco JL, Sola C, M Athanassopoulos C, Carpinella MC. Synthesis and structure-activity relationships of novel abietane diterpenoids with activity against Staphylococcus aureus. Future Med Chem 2019; 11:3109-24. [PMID: 31838897 DOI: 10.4155/fmc-2019-0192] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aim: To find alternative compounds against methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus (MSSA), novel derivatives from dehydroabietic acid were synthesized. Methods & results: Compound 12 was the most effective against 15 MRSA and 11 MSSA with minimum inhibitory concentration values ranging from 3.9 to 15.6 μg/ml. Although less active than 12, compound 11, followed by 25 and 13, also exhibited anti-staphylococcal activity. Additional studies showed that compound 12 is devoid of toxic effect on non-target cells. A structure-activity relationship study revealed that an oxime at C-13 together with a hydroxyl at C-12 could play a key role in the activity. Conclusion: These structures, in particular compound 12, could arise as templates for the development of agents against MRSA and MSSA.
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20
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Parrish KL, Wylie KM, Reich PJ, Hogan PG, Wylie TN, Kennedy CR, Lainhart W, Hunstad DA, Burnham CAD, Fritz SA. Carriage of the Toxic Shock Syndrome Toxin Gene by Contemporary Community-Associated Staphylococcus aureus Isolates. J Pediatric Infect Dis Soc 2019; 8:470-473. [PMID: 30285124 PMCID: PMC6831934 DOI: 10.1093/jpids/piy098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 09/13/2018] [Indexed: 01/02/2023]
Abstract
We report here the prevalence of the tst-1 gene among 252 methicillin-susceptible Staphylococcus aureus (MSSA) isolates and 458 methicillin-resistant S aureus (MRSA) isolates collected from 531 subjects between 2008 and 2017, one of which was recovered from a child with MRSA toxic shock syndrome. tst-1 was encoded by 43 (6%) S aureus isolates overall: 42 (16.7%) MSSA isolates and 1 (0.2%) MRSA isolate (P < .001).
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Affiliation(s)
- Katelyn L Parrish
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Kristine M Wylie
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Patrick J Reich
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Patrick G Hogan
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Todd N Wylie
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Colleen R Kennedy
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - William Lainhart
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
| | - David A Hunstad
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri
| | - Carey-Ann D Burnham
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri
| | - Stephanie A Fritz
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
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21
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Beganovic M, Cusumano JA, Lopes V, LaPlante KL, Caffrey AR. Comparative Effectiveness of Exclusive Exposure to Nafcillin or Oxacillin, Cefazolin, Piperacillin/Tazobactam, and Fluoroquinolones Among a National Cohort of Veterans With Methicillin-Susceptible Staphylococcus aureus Bloodstream Infection. Open Forum Infect Dis 2019; 6:ofz270. [PMID: 31281864 DOI: 10.1093/ofid/ofz270] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 06/04/2019] [Indexed: 01/10/2023] Open
Abstract
Objective Beta-lactam antibiotics are recommended as first-line for treatment of methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia. The objective of this study was to compare effectiveness of anti-MSSA therapies among bacteremia patients exclusively exposed to 1 antimicrobial. Method This was a national retrospective cohort study of patients hospitalized in Veterans Affairs medical centers with MSSA bacteremia from January 1, 2002, to October 1, 2015. Patients were included if they were treated exclusively with nafcillin, oxacillin, cefazolin, piperacillin/tazobactam, or fluoroquinolones (moxifloxacin and levofloxacin). We assessed 30-day mortality, time to discharge, inpatient mortality, 30-day readmission, and 30-day S. aureus reinfection. Hazard ratios (HRs) and 95% confidence intervals (CI) were calculated using propensity-score (PS) matched Cox proportional hazards regression model. Results When comparing nafcillin/oxacillin (n = 105) with cefazolin (n = 107), 30-day mortality was similar between groups (PS matched n = 44; HR, 0.67; 95% CI, 0.11-4.00), as were rates of the other outcomes assessed. As clinical outcomes did not vary between nafcillin/oxacillin and cefazolin, they were combined for comparison with piperacillin/tazobactam (n = 113) and fluoroquinolones (n = 103). Mortality in the 30 days after culture was significantly lower in the nafcillin/oxacillin/cefazolin group compared with piperacillin/tazobactam (PS matched n = 48; HR, 0.10; 95% CI, 0.01-0.78), and similar when compared with fluoroquinolones (PS matched n = 32; HR, 1.33; 95% CI, 0.30-5.96). Conclusions In hospitalized patients with MSSA bacteremia, no difference in mortality was observed between nafcillin/oxacillin and cefazolin or fluoroquinolones. However, higher mortality was observed with piperacillin/tazobactam as compared with nafcillin/oxacillin/cefazolin, suggesting it may not be as effective as a monotherapy in MSSA bacteremia.
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Affiliation(s)
- Maya Beganovic
- Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Rhode Island.,College of Pharmacy, University of Rhode Island, Kingston
| | - Jaclyn A Cusumano
- Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Rhode Island.,College of Pharmacy, University of Rhode Island, Kingston
| | - Vrishali Lopes
- Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Rhode Island
| | - Kerry L LaPlante
- Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Rhode Island.,College of Pharmacy, University of Rhode Island, Kingston.,Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Medical Center, Rhode Island.,Warren Alpert Medical School of Brown University, Division of Infectious Diseases, Providence, Rhode Island
| | - Aisling R Caffrey
- Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Rhode Island.,College of Pharmacy, University of Rhode Island, Kingston.,Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Medical Center, Rhode Island.,Brown University School of Public Health, Providence, Rhode Island
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22
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You AS, Fukunaga BT, Hanlon AL, Lozano AJ, Goo RA. The Daniel K. Inouye College of Pharmacy Scripts: The Effects of Vancomycin Use and De-escalation in Patients Hospitalized with Pneumonia. Hawaii J Med Public Health 2018; 77:261-267. [PMID: 30324005 PMCID: PMC6176271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) causes about 80,000 severe infections each year. Compared to Methicillin-susceptible Staphylococcus aureus (MSSA), MRSA is associated with higher mortality and increased hospital length of stay (LOS). Vancomycin hydrochloride, an antibiotic with activity against MRSA is often used as empiric therapy for pneumonia. However, current pneumonia treatment guidelines recommend against the routine use of MRSA coverage since MRSA prevalence rates are low. In this retrospective, observational study, 38.3% of the population received vancomycin while only 2.6% had evidence of a MRSA infection. Data was gathered manually from electronic medical records from four hospitals over a six-month period. To identify a well-balanced comparison and account for potential confounders, matching on the propensity scores was conducted. Prior to matching, those who received vancomycin had a significantly higher rate of mortality (14.3% vs 4.9%, P < .001) and higher LOS (9.6 days vs 7.2 days, P < .001). Those who were de-escalated from vancomycin had a significantly lower LOS (8.3 days vs 11.6 days, P = .001) with no difference in mortality. After performing a survival analysis on matching data, those who received vancomycin had a significantly higher LOS (9.2 days vs 7.5 days, P = .002) with no difference in mortality (P = .1737). Those who were de-escalated had a significantly lower LOS (8.3 days vs 11.3 days, P=.005) with no difference in mortality (P = .8624). This study demonstrates a low prevalence of MRSA with the potential overuse of vancomycin. This along with no difference in mortality and a lower LOS supports the recommendation to limit vancomycin use as clinically appropriate. If vancomycin is used, assessment for rapid de-escalation is needed.
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Affiliation(s)
- Aryn S You
- The Daniel K. Inouye College of Pharmacy, University of Hawai'i at Hilo, Hilo, HI (ASY, BTF, ALH, AJL, RAG)
- Hawai'i Pacific Health, Honolulu, HI (ASY, BTF, RAG)
| | - Bryce T Fukunaga
- The Daniel K. Inouye College of Pharmacy, University of Hawai'i at Hilo, Hilo, HI (ASY, BTF, ALH, AJL, RAG)
- Hawai'i Pacific Health, Honolulu, HI (ASY, BTF, RAG)
| | - Alexandra L Hanlon
- The Daniel K. Inouye College of Pharmacy, University of Hawai'i at Hilo, Hilo, HI (ASY, BTF, ALH, AJL, RAG)
- Hawai'i Pacific Health, Honolulu, HI (ASY, BTF, RAG)
| | - Alicia J Lozano
- The Daniel K. Inouye College of Pharmacy, University of Hawai'i at Hilo, Hilo, HI (ASY, BTF, ALH, AJL, RAG)
- Hawai'i Pacific Health, Honolulu, HI (ASY, BTF, RAG)
| | - Roy A Goo
- The Daniel K. Inouye College of Pharmacy, University of Hawai'i at Hilo, Hilo, HI (ASY, BTF, ALH, AJL, RAG)
- Hawai'i Pacific Health, Honolulu, HI (ASY, BTF, RAG)
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23
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Zarizal S, Yeo CC, Faizal GM, Chew CH, Zakaria ZA, Jamil Al-Obaidi MM, Syafinaz Amin N, Mohd Nasir MD. Nasal colonisation, antimicrobial susceptibility and genotypic pattern of Staphylococcus aureus among agricultural biotechnology students in Besut, Terengganu, east coast of Malaysia. Trop Med Int Health 2018; 23:905-913. [PMID: 29873865 DOI: 10.1111/tmi.13090] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study aimed to profile the antimicrobial susceptibility and presence of resistance and virulence genes of methicillin-susceptible Staphylococcus aureus (MSSA) and MRSA nasal carriage, by means of genotypic analyses, in students of a tertiary institution in the state of Terengganu, east coast of Malaysia. METHODS A total of 370 agricultural biotechnology students from Universiti Sultan Zainal Abidin in Besut, Terengganu, were enrolled in this study. Antimicrobial susceptibility profiles were evaluated by standard methods. PCR detection of resistance and virulence genes was performed on S. aureus that were methicillin-resistant, macrolide-lincosamide-streptogramin B (MLSB )-positive phenotype and/or positive for the leukocidin (pvl) gene followed by staphylococcal cassette chromosome mec (SCCmec), staphylococcal protein A (spa) and accessory gene regulator (agr) typing. RESULTS One hundred and nineteen of 370 students carried S. aureus (32%); 18 of the isolates were MRSA (15%). Erythromycin resistance was detected in 20% (24/119) of which 15% (18/119) were MRSA and 5% (6/119) MSSA. Among the 24 erythromycin-resistant isolates, D-test was positive in 29% (7/24) displaying inducible MLSB , whereas the remaining 71% (17/24) showed constitutive MLSB phenotypes. Nine (7.6%) of 119 isolates were pvl positive: 44% MRSA (4/9) and 56% MSSA (5/9). Staphylococcal surface protein sasX gene was present in 92% of MRSA and 8% of MSSA isolates. The majority of MRSA isolates were agr type I (15/18; 83%). Five spa types identified with spa t037 were predominant, followed by spa types (t304 and t8696) as newly reported Malaysian MRSA in a community setting. CONCLUSION The presence of MRSA with SCCmec of hospital-associated features and globally recognised spa types in community setting is worrisome. Furthermore, the presence of MLSB strains among multidrug-resistant (MDR) S. aureus with sasX as well as pvl-positive isolates highlights the potential risk of a community setting in facilitating the dissemination of both virulence and resistance determinants.
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Affiliation(s)
- Suhaili Zarizal
- School of Animal Sciences, Faculty of Bioresources and Food Industry, Universiti Sultan Zainal Abidin, Besut, Terengganu, Malaysia.,Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Chew Chieng Yeo
- Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Terengganu, Malaysia
| | - Ghazali Mohd Faizal
- School of Animal Sciences, Faculty of Bioresources and Food Industry, Universiti Sultan Zainal Abidin, Besut, Terengganu, Malaysia
| | - Ching Hoong Chew
- Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Gong Badak, Terengganu, Malaysia
| | - Zainul Amiruddin Zakaria
- Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.,Laboratory of Halal Science Research, Halal Products Research Institute, Universiti Putra Malaysia, Serdang, Malaysia
| | - Mazen M Jamil Al-Obaidi
- Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Nordin Syafinaz Amin
- Department of Medical Microbiology and Parasitology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Mohd Desa Mohd Nasir
- Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.,Laboratory of Halal Science Research, Halal Products Research Institute, Universiti Putra Malaysia, Serdang, Malaysia
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24
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Miller WR, Seas C, Carvajal LP, Diaz L, Echeverri AM, Ferro C, Rios R, Porras P, Luna C, Gotuzzo E, Munita JM, Nannini E, Carcamo C, Reyes J, Arias CA. The Cefazolin Inoculum Effect Is Associated With Increased Mortality in Methicillin-Susceptible Staphylococcus aureus Bacteremia. Open Forum Infect Dis 2018; 5:ofy123. [PMID: 29977970 PMCID: PMC6007512 DOI: 10.1093/ofid/ofy123] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/23/2018] [Indexed: 12/15/2022] Open
Abstract
Background Recent studies have favored the use of cefazolin over nafcillin for the treatment of methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia. The clinical influence of the cefazolin inoculum effect (CzIE) in the effectiveness of cephalosporins for severe MSSA infections has not been evaluated. Methods We prospectively included patients from 3 Argentinian hospitals with S. aureus bacteremia. Cefazolin minimum inhibitory concentrations (MICs) were determined at standard (105 colony-forming units [CFU]/mL) and high (107 CFU/mL) inoculum. The CzIE was defined as an increase of MIC to ≥16 µg/mL when tested at high inoculum. Whole-genome sequencing was performed in all isolates. Results A total of 77 patients, contributing 89 MSSA isolates, were included in the study; 42 patients (54.5%) had isolates with the CzIE. In univariate analysis, patients with MSSA exhibiting the CzIE had increased 30-day mortality (P = .034) and were more likely to have catheter-associated or unknown source of bacteremia (P = .033) compared with patients infected with MSSA isolates without the CzIE. No statistically significant difference between the groups was observed in age, clinical illness severity, place of acquisition (community vs hospital), or presence of endocarditis. The CzIE remained associated with increased 30-day mortality in multivariate analysis (risk ratio, 2.65; 95% confidence interval, 1.10–6.42; P = .03). MSSA genomes displayed a high degree of heterogeneity, and the CzIE was not associated with a specific lineage. Conclusions In patients with MSSA bacteremia where cephalosporins are used as firstline therapy, the CzIE was associated with increased 30-day mortality. Clinicians should be cautious when using cefazolin as firstline therapy for these infections.
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Affiliation(s)
- William R Miller
- Center for Antimicrobial Resistance and Microbial Genomics, Houston, Texas.,Division of Infectious Diseases, Department of Internal Medicine, Houston, Texas
| | - Carlos Seas
- Hospital Cayetano Heredia and Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Lina P Carvajal
- Molecular Genetics and Antimicrobial Resistance Unit and International Center for Antimicrobial Resistance, Universidad El Bosque, Bogota, Colombia
| | - Lorena Diaz
- Center for Antimicrobial Resistance and Microbial Genomics, Houston, Texas.,Molecular Genetics and Antimicrobial Resistance Unit and International Center for Antimicrobial Resistance, Universidad El Bosque, Bogota, Colombia
| | - Aura M Echeverri
- Molecular Genetics and Antimicrobial Resistance Unit and International Center for Antimicrobial Resistance, Universidad El Bosque, Bogota, Colombia
| | - Carolina Ferro
- Molecular Genetics and Antimicrobial Resistance Unit and International Center for Antimicrobial Resistance, Universidad El Bosque, Bogota, Colombia
| | - Rafael Rios
- Molecular Genetics and Antimicrobial Resistance Unit and International Center for Antimicrobial Resistance, Universidad El Bosque, Bogota, Colombia
| | - Paola Porras
- Molecular Genetics and Antimicrobial Resistance Unit and International Center for Antimicrobial Resistance, Universidad El Bosque, Bogota, Colombia
| | - Carlos Luna
- Pulmonary Division, Department of Medicine, Jose de San Martin Hospital, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Eduardo Gotuzzo
- Hospital Cayetano Heredia and Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jose M Munita
- Center for Antimicrobial Resistance and Microbial Genomics, Houston, Texas.,Genomics and Resistant Microbes (GeRM) group, Clinica Alemana, Universidad del Desarrollo, Santiago, Chile
| | - Esteban Nannini
- Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Rosario, Argentina
| | - Cesar Carcamo
- Hospital Cayetano Heredia and Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Jinnethe Reyes
- Center for Antimicrobial Resistance and Microbial Genomics, Houston, Texas.,Molecular Genetics and Antimicrobial Resistance Unit and International Center for Antimicrobial Resistance, Universidad El Bosque, Bogota, Colombia
| | - Cesar A Arias
- Center for Antimicrobial Resistance and Microbial Genomics, Houston, Texas.,Division of Infectious Diseases, Department of Internal Medicine, Houston, Texas.,Department of Microbiology and Molecular Genetics, UTHealth McGovern Medical School, Houston, Texas.,Molecular Genetics and Antimicrobial Resistance Unit and International Center for Antimicrobial Resistance, Universidad El Bosque, Bogota, Colombia
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25
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Carr DR, Stiefel U, Bonomo RA, Burant CJ, Sims SV. A Comparison of Cefazolin Versus Ceftriaxone for the Treatment of Methicillin-Susceptible Staphylococcus aureus Bacteremia in a Tertiary Care VA Medical Center. Open Forum Infect Dis 2018; 5:ofy089. [PMID: 30568987 DOI: 10.1093/ofid/ofy089] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/15/2018] [Indexed: 01/03/2023] Open
Abstract
Background Cefazolin and ceftriaxone are frequently used to treat methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia, especially in the realm of outpatient parenteral antimicrobial therapy. Both antimicrobials have been associated with favorable clinical outcomes for mixed MSSA infections. However, limited published data exist specifically comparing the use of these agents for the treatment of MSSA bacteremia. Methods We conducted a retrospective cohort study of Veteran patients with MSSA bacteremia who received ≥14 days of cefazolin or ceftriaxone between 2009 and 2014. Rates of treatment failure were compared between both groups. Treatment failure was defined as therapy extension, incomplete therapy, unplanned oral suppressive therapy, relapse of infection, or hospital admission or surgery within 90 days. Results Out of 71 patients, 38 received treatment with cefazolin and 33 with ceftriaxone. The overall rate of treatment failure was 40.8%, with significantly more failures among patients receiving ceftriaxone (54.5% versus 28.9%; P = .029). Factors associated with treatment failure included longer duration of parenteral therapy, heart failure, and treatment in an external skilled nursing facility as compared with treatment in the Department of Veterans Affairs attached Community Living Center. Conclusions Ceftriaxone had a higher rate of treatment failure than cefazolin for the treatment of MSSA bacteremia in a Veteran population. Potential reasons for this could include the higher protein binding of ceftriaxone, ultimately resulting in lower serum concentrations of free drug, or other unknown factors. Further studies are warranted to confirm these results.
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Affiliation(s)
- Dustin R Carr
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
| | - Usha Stiefel
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio.,Case Western Reserve University, Cleveland, Ohio
| | - Robert A Bonomo
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio.,Case Western Reserve University, Cleveland, Ohio
| | - Christopher J Burant
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio.,Case Western Reserve University, Cleveland, Ohio
| | - Sharanie V Sims
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio
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26
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Turner NA, Moehring R, Sarubbi C, Wrenn RH, Drew RH, Cunningham CK, Fowler VG, Anderson DJ. Influence of Reported Penicillin Allergy on Mortality in MSSA Bacteremia. Open Forum Infect Dis 2018; 5:ofy042. [PMID: 29594180 PMCID: PMC5861429 DOI: 10.1093/ofid/ofy042] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background Penicillin allergy frequently impacts antibiotic choice. As beta-lactams are superior to vancomycin in treating methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia, we examined the effect of reported penicillin allergy on clinical outcomes in patients with MSSA bacteremia. Methods In this retrospective cohort study of adults with MSSA bacteremia admitted to a large tertiary care hospital, outcomes were examined according to reported penicillin allergy. Primary outcomes included 30-day and 90-day mortality rates. Multivariable regression models were developed to quantify the effect of reported penicillin allergy on mortality while adjusting for potential confounders. Results From 2010 to 2015, 318 patients with MSSA bacteremia were identified. Reported penicillin allergy had no significant effect on adjusted 30-day mortality (odds ratio [OR], 0.73; 95% confidence interval [CI], 0.29-1.84; P = .51). Patients with reported penicillin allergy were more likely to receive vancomycin (38% vs 11%, P < .01), but a large number received cefazolin regardless of reported allergy (29 of 66, 44%). Mortality rates were highest among nonallergic patients receiving vancomycin (22.6% vs 7.4% for those receiving beta-lactams regardless of reported allergy, P < .01). In multivariable analysis, beta-lactam receipt was most strongly associated with survival (OR, 0.26; 95% CI, 0.12-0.54). Conclusions Reported penicillin allergy had no significant effect on 30- or 90-day mortality. Non-penicillin-allergic patients receiving vancomycin for treatment of MSSA bacteremia had the highest mortality rates overall. Receipt of a beta-lactam was the strongest predictor of survival. These results underscore the importance of correct classification of patients with penicillin allergy and appropriate treatment with a beta-lactam when tolerated.
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Affiliation(s)
- Nicholas A Turner
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Rebekah Moehring
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Christina Sarubbi
- Department of Pharmacy, Duke University Hospital, Durham, North Carolina
| | - Rebekah H Wrenn
- Department of Pharmacy, Duke University Hospital, Durham, North Carolina
| | - Richard H Drew
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Coleen K Cunningham
- Division of Infectious Diseases, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina
| | - Vance G Fowler
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.,Duke Clinical Research Institute, Durham, North Carolina
| | - Deverick J Anderson
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, North Carolina
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Abstract
OBJECTIVES The primary objective of this study was to describe the clinical outcomes of continuous nafcillin infusion in pediatric patients. METHODS This was a retrospective case study performed at a freestanding, tertiary care children's hospital. Subjects were included if they were at least 30 days old and had received more than 1 dose of nafcillin by continuous infusion (CI) between January 1, 2009, and December 31, 2012. Clinical and microbiological data were extracted from the medical record. Documented adverse events potentially associated with nafcillin were recorded. Treatment success was defined by any one of the following outcomes without the presence of conflicting data: microbiological cure, prescriber-documented treatment success, or normalization of abnormal clinical or laboratory parameters. RESULTS Forty subjects with a median of 9 (interquartile range [IQR], 2.3-12) years of age were included. Median length of stay (in days) for all indications observed was 7 (IQR, 5-21.8) days. Extended lengths of stay, indicated by ≥10 days, were more common in cases of endocarditis, skin and soft tissue infection, and bacteremia. Adverse reactions were documented in 20% of patients. CONCLUSIONS In this pediatric study, overall treatment success was observed in 92.5% of patients. Microbiological cure was documented in 91.3% of patients by using follow-up cultures. Length of stay may be positively impacted by CI nafcillin. Continuously infused nafcillin appears to be an acceptable alternative to intermittently infused nafcillin in children. Further studies are needed to address the question of whether clinical outcomes of CI nafcillin are superior to those of conventional infusion.
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28
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Li J, Echevarria KL, Traugott KA. β-Lactam Therapy for Methicillin-Susceptible Staphylococcus aureus Bacteremia: A Comparative Review of Cefazolin versus Antistaphylococcal Penicillins. Pharmacotherapy 2017; 37:346-360. [PMID: 28035690 DOI: 10.1002/phar.1892] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia is associated with high morbidity and mortality. Traditionally, antistaphylococcal penicillins (ASPs) have been considered the agents of choice for the treatment of MSSA bacteremia. Vancomycin has been demonstrated to have poorer outcomes in several studies and is only recommended for patients with severe penicillin allergies. Although cefazolin is considered as an alternative to the ASPs for patients with nonsevere penicillin allergies, cefazolin offers several pharmacologic advantages over ASPs, such as more convenient dosing regimens, and antimicrobial stewardship programs are increasingly using cefazolin as the preferential agent for MSSA infections as part of cost-saving initiatives. Concerns about susceptibility to hydrolysis by type A β-lactamases, particularly at high inocula seen in deep-seated infections such as endocarditis; selective pressures from unnecessary gram-negative coverage; and lack of comparative clinical data have precluded recommending cefazolin as a first-line therapy for MSSA bacteremia. Recent clinical studies, however, have suggested similar clinical efficacy but better tolerability, with lower rates of discontinuation due to adverse drug reactions, of cefazolin compared with ASPs. Other variables, such as adequate source control (e.g., intravascular catheter removal, debridement, or drainage) and enhanced pharmacodynamics through aggressive cefazolin dosing, may mitigate the role of cefazolin inoculum effect and factor into determining improved clinical outcomes. In this review, we highlight the utility of cefazolin versus ASPs in the treatment of MSSA bacteremia with a focus on clinical efficacy and safety.
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Affiliation(s)
- Julius Li
- Department of Pharmacy, Ochsner Medical Center, New Orleans, Louisiana
| | - Kelly L Echevarria
- South Texas Veterans Health Care System, San Antonio, Texas.,The University of Texas at Austin College of Pharmacy, Austin, Texas.,Pharmacotherapy Education and Research Center, University of Texas Health Sciences Center San Antonio, San Antonio, Texas
| | - Kristi A Traugott
- The University of Texas at Austin College of Pharmacy, Austin, Texas.,Pharmacotherapy Education and Research Center, University of Texas Health Sciences Center San Antonio, San Antonio, Texas.,Department of Pharmacy, University Health System, San Antonio, Texas
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29
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Abstract
The dissemination of methicillin-resistant (MR) Staphylococcus aureus (SA) in community and health-care settings is of great concern and associated with high mortality and morbidity. Rapid detection of MRSA with short turnaround time can minimize the time to initiate appropriate therapy and further promote infection control. Early detection of MRSA directly from clinical samples is complicated by the frequent association of MRSA with methicillin-susceptible SA (MSSA) and coagulase-negative Staphylococcus (CoNS) species. Infection associated with true MRSA or MSSA is differentiated from CoNS, requires target specific primers for the presence of SA and mec A or nuc or fem A gene for confirmation of MR. Recently, livestock-associated MRSA carrying mec C variant complicates the epidemiology of MRSA further. Several commercial rapid molecular kits are available with a different combination of these targets for the detection of MRSA or MSSA. The claimed sensitivity and specificity of the currently available commercial kits is varying, because of the different target combination used for detection of SA and MR.
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Affiliation(s)
| | - Laura E B Nabarro
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India; Department of Infectious Disease, Public Health England, London, UK
| | - Balaji Veeraraghavan
- Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
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30
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Davoodabadi F, Mobasherizadeh S, Mostafavizadeh K, Shojaei H, Havaei SA, Koushki AM, Moghadasizadeh Z, Meidani M, Shirani K. Nasal colonization in children with community acquired methicillin-resistant Staphylococcus aureus. Adv Biomed Res 2016; 5:86. [PMID: 27274501 PMCID: PMC4879855 DOI: 10.4103/2277-9175.182217] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 12/06/2014] [Indexed: 12/03/2022] Open
Abstract
Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a frequent cause of infections. The changing epidemiology of MRSA became evident in the 1990s when CA-MRSA cases were first reported. Nasal carriage of CA-MRSA is associated with an increased risk for development of infections in various populations. Materials and Methods: Anterior nares culture for the presence of methicillin-susceptible Staphylococcus aureus (MSSA) and MRSA was taken from 345 children attending kindergartens, who didn’t have any known risk factor for MRSA colonization. Also, children demographic variables were recorded. Identification of SA and community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) with standard microbiological test was performed. Finally, the susceptibility of isolated to various antibiotics determined. The data were analyzed with Whonet 5.6 software. Results: Of 345 children, 20 children (5.8%) were colonized with CA-MRSA, 86 children (24.9%) with MSSA and 239 cases (69.3%) didn’t have SA colonization. The highest rate of MSSA and MRSA colonization was obtained at the age of 6 years. The frequency distribution of SA (MSSA and MRSA) colonization prevalence didn’t have any significant differences based on age, gender and the admission time (P > 0.05); but it was significantly different in the urban areas (P < 0.001). The lowest resistance rate of CA-MRSA isolates, with a frequency of 10%, was detected with gentamicin, rifampin, and trimethoprim-sulfamethoxazole. Conclusions: In summary, CA-MRSA colonization was observed in child care centers remarkably. Therefore, by facing various infections due to SA especially in areas of low socio-economic status, it must be considered. Based on antibiogram test, empirical treatment with rifampin, gentamicin and ciprofloxacin is recommended during CA-MRSA infections.
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Affiliation(s)
- Fazlollah Davoodabadi
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sina Mobasherizadeh
- Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Kamyar Mostafavizadeh
- Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hasan Shojaei
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Seyed Asghar Havaei
- Department of Microbiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Mehrabi Koushki
- Department of Epidemiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Moghadasizadeh
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohsen Meidani
- Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Kiana Shirani
- Acquired Immunodeficiency Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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31
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Kapoor R, Barnett CJ, Gutmann RM, Yildiz VO, Joseph NC, Stoicea N, Reyes S, Rogers BM. Preoperative Prevalence of Staphylococcus aureus in Cardiothoracic and Neurological Surgical Patients. Front Public Health 2014; 2:204. [PMID: 25405147 PMCID: PMC4217322 DOI: 10.3389/fpubh.2014.00204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 10/07/2014] [Indexed: 11/23/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a global cause of both hospital and community-acquired infection. This retrospective, observational study determined the prevalence of MRSA carriers in cardiothoracic and neurological surgical patients presenting to an outpatient preoperative assessment center in Columbus, OH. Aggressive skin and soft-tissue infection may be caused by MRSA with potentially fatal complications. Cardiothoracic and neurological surgical patients are at high risk for surgical-site infection. Results indicated that 4.25% of the sample carried MRSA and 25.25% carried methicillin-sensitive S. aureus.
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Affiliation(s)
- Ritu Kapoor
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University , Columbus, OH , USA
| | | | - Rebecca M Gutmann
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University , Columbus, OH , USA
| | - Vedat O Yildiz
- Department of Biomedical Informatics, Wexner Medical Center, The Ohio State University , Columbus, OH , USA
| | | | - Nicoleta Stoicea
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University , Columbus, OH , USA
| | | | - Barbara M Rogers
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University , Columbus, OH , USA
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32
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Ho CM, Lin CY, Ho MW, Lin HC, Peng CT, Lu JJ. Concomitant genotyping revealed diverse spreading between methicillin-resistant Staphylococcus aureus and methicillin-susceptible Staphylococcus aureus in central Taiwan. J Microbiol Immunol Infect 2014; 49:363-70. [PMID: 25305708 DOI: 10.1016/j.jmii.2014.07.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 06/17/2014] [Accepted: 07/04/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND Staphylococcus aureus is a versatile bacterium, which can lead to various infectious diseases. Various molecular typing methods are applied to the evolution and epidemiology surveys of S. aureus, mostly for methicillin-resistant S. aureus (MRSA). However, methicillin-susceptible S. aureus (MSSA) is still an important pathogen, but their molecular typing is evaluated infrequently. METHODS Pulsed-field gel electrophoresis (PFGE), spa typing, and detection of five virulent genes for 95 MRSA and 56 MSSA isolates (July-December 2008 and July 2008-December 2009, respectively) during an overlapping period were performed. RESULTS More diversity was found in MSSA isolates (23 pulsotypes and 25 spa types, excluding 4 new-type and 1 nontypable isolates for spa typing) than in MRSA isolates (19 pulsotypes and 16 spa types, excluding 1 new-type and 1 nontypable isolates for spa typing). By spa typing, t002 (n = 30), t037 (n = 23), t437 (n = 21), t234 (n = 3), t1081 (n = 3), and t1094 (n = 3) were the six major MRSA clones. For MSSA isolates, t189 (n = 13), t437 (n = 4), t084 (n = 3), t213 (n = 3), t701 (n = 3), and t7200 (n = 3) were the six major types. Combining PFGE and spa typing, there were five combinations (pulsotype + spa type) that contained both MRSA and MSSA isolates (pulsotype 9-t437, pulsotype 15-t037, pulsotype 19-t002, pulsotype 21-t002, and pulsotype 28-t1081). For all 151 S. aureus or 95 MRSA isolates, the PFGE typing had more discrimination power, but spa typing had larger discrimination index for 56 MSSA isolates. CONCLUSION In conclusion, there were different predominant MRSA and MSSA clones clinically. Continuing longitudinal tracking of molecular typing is necessary for elucidating the evolution of this important clinical pathogen.
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Affiliation(s)
- Cheng-Mao Ho
- Department of Laboratory Medicine, China Medical University Hospital, Taichung, Taiwan; Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Nursing, Hungkuang University, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan
| | - Chien-Yu Lin
- Department of Laboratory Medicine, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Mao-Wang Ho
- Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Hsiao-Chuan Lin
- Department of Pediatrics, Children's Hospital, China Medical University, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan
| | - Ching-Tien Peng
- Department of Pediatrics, Children's Hospital, China Medical University, Taichung, Taiwan; Department of Biotechnology, Asia University, Taichung, Taiwan
| | - Jang-Jih Lu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan; Department of Laboratory Medicine, Chang-Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Kweishan, Taoyuan, Taiwan.
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33
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van Cleef BAGL, van Benthem BHB, Verkade EJM, van Rijen M, Kluytmans-van den Bergh MFQ, Schouls LM, Duim B, Wagenaar JA, Graveland H, Bos MEH, Heederik D, Kluytmans JAJW. Dynamics of methicillin-resistant Staphylococcus aureus and methicillin-susceptible Staphylococcus aureus carriage in pig farmers: a prospective cohort study. Clin Microbiol Infect 2014; 20:O764-71. [PMID: 24494859 DOI: 10.1111/1469-0691.12582] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 12/27/2013] [Accepted: 01/27/2014] [Indexed: 02/06/2023]
Abstract
Our purpose was to determine the dynamics of livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) carriage and its determinants in persons working at pig farms, in order to identify targets for interventions. This prospective cohort study surveyed 49 pig farms in the Netherlands on six sampling dates in 1 year (2010-11). Nasal and oropharyngeal swabs were collected, as well as environmental surface samples from stables and house. Of 110 pig farmers, 38% were persistent MRSA nasal carriers. The average cross-sectional MRSA prevalence was 63%. Methicillin-susceptible S. aureus (MSSA) nasal carriage was associated with fewer MRSA acquisitions (prevalence rate (PR) = 0.47, p 0.02). In multivariate analysis, an age of 40-49 years (PR = 2.13, p 0.01), a working week of ≥40 h (PR=1.89, p 0.01), giving birth assistance to sows (PR=2.26, p 0.03), removing manure of finisher pigs (PR=0.48, p 0.02), and wearing a facemask (PR = 0.13, p 0.02) were significantly related with persistent MRSA nasal carriage. A higher MRSA exposure in stables was associated with MRSA in pig farmers (p <0.0001). This study describes a very high prevalence of LA-MRSA carriage in pig farmers, reflecting extensive exposure during work. We identified the possible protective effects of MSSA carriage and of continuously wearing a facemask during work.
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Affiliation(s)
- B A G L van Cleef
- Laboratory for Microbiology and Infection Control, Amphia Hospital, Breda, the Netherlands; Laboratory for Medical Microbiology and Immunology, St Elisabeth Hospital, Tilburg, the Netherlands; Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment, Bilthoven, the Netherlands
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Cervera C, Castañeda X, de la Maria CG, del Rio A, Moreno A, Soy D, Pericas JM, Falces C, Armero Y, Almela M, Ninot S, Pare JC, Mestres CA, Gatell JM, Marco F, Miro JM. Effect of vancomycin minimal inhibitory concentration on the outcome of methicillin-susceptible Staphylococcus aureus endocarditis. Clin Infect Dis 2014; 58:1668-75. [PMID: 24647021 DOI: 10.1093/cid/ciu183] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Staphylococcus aureus endocarditis has a high mortality rate. Vancomycin minimum inhibitory concentration (MIC) has been shown to affect the outcome of methicillin-resistant S. aureus bacteremia, and recent data point to a similar effect on methicillin-susceptible S. aureus bacteremia. We aimed to evaluate the effect of vancomycin MIC on left-sided S. aureus infective endocarditis (IE) treated with cloxacillin. METHODS We analyzed a prospectively collected cohort of patients with IE in a single tertiary-care hospital. Vancomycin, daptomycin, and cloxacillin MIC was determined by E-test. S. aureus strains were categorized as low vancomycin MIC (<1.5 µg/mL) and high vancomycin MIC (≥1.5 µg/mL). The primary endpoint was in-hospital mortality. RESULTS We analyzed 93 patients with left-sided IE treated with cloxacillin, of whom 53 (57%) had a vancomycin MIC < 1.5 µg/mL and 40 (43%) a vancomycin MIC ≥ 1.5 µg/mL. In-hospital mortality was 30% (n = 16/53) in patients with a low vancomycin MIC and 53% (n = 21/40) in those with a high vancomycin MIC (P = .03). No correlation was found between oxacillin MIC and vancomycin or daptomycin MIC. Logistic regression analysis showed that higher vancomycin MIC increased in-hospital mortality 3-fold (odds ratio, 3.1; 95% confidence interval, 1.2-8.2) after adjustment for age, year of diagnosis, septic complications, and nonseptic complicated endocarditis. CONCLUSIONS Our results indicate that vancomycin MIC could be used to identify a subgroup of patients with methicillin-susceptible S. aureus IE at risk of higher mortality. The worse outcome of staphylococcal infections with a higher vancomycin MIC cannot be explained solely by suboptimal pharmacokinetics of antibiotics.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Salvador Ninot
- Department of Cardiovascular Surgery, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Carlos A Mestres
- Department of Cardiovascular Surgery, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
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35
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Valour F, Tasse J, Trouillet-Assant S, Rasigade JP, Lamy B, Chanard E, Verhoeven P, Decousser JW, Marchandin H, Bès M, Chidiac C, Vandenesch F, Ferry T, Laurent F. Methicillin-susceptible Staphylococcus aureus clonal complex 398: high prevalence and geographical heterogeneity in bone and joint infection and nasal carriage. Clin Microbiol Infect 2014; 20:O772-5. [PMID: 24461054 DOI: 10.1111/1469-0691.12567] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Revised: 12/15/2013] [Accepted: 01/21/2014] [Indexed: 11/28/2022]
Abstract
The prevalence of clonal complex (CC) 398 methicillin-susceptible Staphylococcus aureus (MSSA) was unexpectedly high among bone and joint infections (BJIs) and nasal-colonizing isolates in France, with surprising geographical heterogeneity. With none of the major, most-known staphylococcal virulence genes, MSSA CC398 BJI was associated with lower biological inflammatory syndrome and lower treatment failure rates.
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Affiliation(s)
- F Valour
- Bacteriology Department, Groupement Hospitalier Nord, Hospices Civils de Lyon, Lyon, France; Infectious Diseases Department, Hospices Civils de Lyon, Lyon, France; International Centre for Research in Infectious Diseases, INSERM U1111, Université Claude Bernard Lyon 1, Lyon, France
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